Shock

Small Animal Critical Care Medicine

Volumn , Issue , 2009, Pages 41-45

  de Laforcade, Armelle M ^a   Silverstein, Deborah C ^b  

^a TUFTS UNIVERSITY   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 58149249114     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1016/B978-1-4160-2591-7.10010-4     Document Type: Chapter

References (10)

1. Boag A, Hughes D Assessment and treatment of perfusion abnormalities in the emergency patient. Vet Clin North Am Small Anim Pract 2005, 35:319.
2. Choi PT, Yip G, Quinonez LG, et al. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999, 27:200.
3. Rivers E, Nguyen B, Havstad S, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345:1368.
4. Silverstein DC, Aldrich J, Haskins SC, et al. Assessment of changes in blood volume in response to resuscitative fluid administration in dog. J Vet Emerg Crit Care 2005, 15:185.
5. Taylor RW Pulmonary Artery Consensus Conference Participants: Consensus statement. Crit Care Med 1997, 25:910.
6. A good discussion on the clinical signs and therapeutic approach to hypoperfusion.
7. This review examined all randomized clinical trials of adult humans requiring fluid resuscitation that compared crystalloid to colloid therapy. No difference in development of pulmonary edema, mortality or length of stay was identified, however reduced mortality was seen in trauma patients receiving isotonic crystalloids.
8. A landmark study that found patients with severe sepsis or septic shock assigned to receive early goal directed therapy from 7 to 72 hours after admission had a significantly higher mean central venous oxygen saturation, lower lactate concentration, lower base deficit, higher pH, and less severe organ dysfunction than the patients assigned to standard therapy.
9. An experimental study in four healthy dogs showing that the rapid administration of saline at clinically relevant doses leads to the largest immediate increase in blood volume. Hypertonic saline led to the smallest increase in blood volume post-infusion and the synthetic colloid solutions increased the blood volume for a longer period of time than the other fluids.
10. The experts in the field recognize that the PAC may be useful in shock unresponsive to fluid resuscitation and vasopressors though it is not clear whether the PAC is superior to other, less invasive forms of monitoring.